Individual provider · Type 1 NPI
Coresair Anton Mack
Professional Counselor · Dekalb, IL
NPI number
1336696582
Active
Practice location
220 E Hillcrest Dr Apt 4210
Dekalb, IL 60115-2452
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Counselor | 101YM0800X | None listed |
| Professional Counselor Primary | 101YP2500X | 180012529 (IL) |
Professional Counselor: Definition to come...
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About NPI 1336696582
Coresair Anton Mack's National Provider Identifier is 1336696582, issued on Sep 6, 2016. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Dekalb, IL. The record was last updated on May 6, 2021.